| NPI | 1972008944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME163937) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IN 01091053A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2024-08-20 |